Eye health

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Exophthalmos – bulging eyes – an overview

Exophthalmos

Exophthalmos

Exophthalmos, also known as proptosis, is a medical term for a bulging or protruding eyeball or eyeballs. It’s most often caused by thyroid eye disease.

Many of the symptoms of thyroid eye disease tend to improve over time, although this can take a number of years. There’s a chance your eyes will continue to protrude if corrective surgery isn’t carried out.

Some people with exophthalmos are left with long-term vision problems, such as double vision. However, permanent visual impairment is rare if the condition is identified and treated promptly.

 

 

When to seek medical advice

See your GP or an optometrist (optician) if you notice that one or both of your eyes are protruding.

It’s important to identify the underlying cause so appropriate treatment can be given. Treatment is often more effective if it’s started as soon as possible.

If necessary, your GP or optometrist can refer you to an ophthalmologist (a specialist in diagnosing and treating eye conditions) for further assessment.

Diagnosing exophthalmos

If you’re referred to an ophthalmologist, they’ll check how well you’re able to move your eyes. They may also use an instrument called an exophthalmometer to measure how far your eyeball protrudes.

If the ophthalmologist wants to examine your eye socket in more detail, a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan may be carried out.

You may also have a blood test to assess how well your thyroid gland is working and you may be referred to an endocrinologist (a specialist in conditions affecting glands and hormones) if you’re found to have abnormal thyroid hormone levels.

Causes of exophthalmos

One of the main causes of exophthalmos in the UK is thyroid eye disease, also known as Graves’ ophthalmopathy.

This is an autoimmune condition that affects around one in every three people with an overactive thyroid gland (hyperthyroidism) caused by Graves’ disease. It’s particularly common in women aged 30-50 and people who smoke.

An autoimmune condition is where the immune system (the body’s defence against illness and infection) mistakenly attacks healthy tissue.

In the case of thyroid eye disease, the immune system attacks the muscles and fatty tissues around and behind the eye, causing them to become inflamed (swollen).

Thyroid eye disease can also occasionally affect people with an underactive thyroid gland (hypothyroidism) and, in rare cases, people with seemingly normal thyroid function.

Other causes

Exophthalmos can also have a number of other causes, but these are generally less common than thyroid eye disease.

Other causes of exophthalmos can include:

an injury to the eyes

bleeding behind the eyes

abnormally shaped blood vessels behind the eyes

an infection of the tissue in the eye socket

cancerous tumours – such as those caused by neuroblastoma and some soft tissue sarcomas

Exophthalmos can also affect newborn babies if they’re born with eye sockets that are shallower than normal.

Treating exophthalmos

If exophthalmos is being caused by thyroid eye disease, the following treatments are often helpful:

medication to correct the level of thyroid hormones in your blood – this won’t necessarily improve the problems with your eyes, but may stop them getting worse

corticosteroid medication given directly into a vein (intravenously) – this can help reduce the inflammation associated with the condition

corrective surgery – this may be carried out to improve the appearance of your eyes once the inflammation is under control

Other useful measures include stopping smoking, using artificial tears to reduce eye dryness and irritation, and wearing special lenses to correct double vision.

In other cases, treatment will vary depending on the underlying cause. For example, treatments such as radiotherapy, chemotherapy and/or surgery may be recommended if exophthalmos is caused by a tumour.

Read more about treating exophthalmos.

Complications of exophthalmos

Depending on what’s causing your bulging eyes, you may also have other associated symptoms. For example, if exophthalmos is caused by a thyroid eye disease, your eyes may also be:

inflamed, red and painful

dry and “gritty”

tearful

sensitive to light (photophobia)

You may also experience some double vision.

In severe cases of exophthalmos, you may not be able to close your eyes properly. This can damage your corneas (the transparent tissue that covers the front of your eye) by causing them to dry out.

If your corneas become very dry, an infection or ulcers (open sores) may develop. These could damage your vision if left untreated.

There’s also a small risk of the optic nerve (which transmits signals from the eye to the brain) becoming compressed if you have exophthalmos, which may affect your sight permanently if it isn’t treated quickly.

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Blepharitis – the sign and symptoms of Blepharitis?

Blepharitis

Blepharitis

Blepharitis is a common condition where the edges of the eyelids (eyelid margins) become red and swollen (inflamed).

Blepharitis can develop at any age, and symptoms can include:

itchy, sore and red eyelids that stick together

crusty or greasy eyelashes

a burning, gritty sensation in your eyes

increased sensitivity to light (photophobia)

swollen eyelid margins

finding contact lenses uncomfortable to wear

abnormal eyelash growth or loss of eyelashes in severe cases

In most cases both eyes are affected, but one eye can be more affected than the other. The symptoms tend to be worse in the morning.

When to get medical advice

See your high-street optician (optometrist) if you have persistent symptoms of blepharitis that aren’t being controlled by simple eyelid hygiene measures.

They can examine you to check if the problem is caused by an underlying condition, or may refer you to an eye specialist.

Contact your optometrist or GP immediately if you have any severe symptoms. If this isn’t possible, visit your nearest accident and emergency (A&E) department.

How blepharitis is treated

Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods without symptoms.

It can’t usually be cured, but a daily eyelid-cleaning routine can help control the symptoms and prevent permanent scarring of the eyelid margins.

There are three main steps to eyelid hygiene that should be performed once or twice a day:

using a warm compress – to make the oil produced by the glands around your eyes more runny

gently massaging your eyelids – to push the oils out of the glands

cleaning your eyelids – to wipe away any excess oil and remove any crusts, bacteria, dust or grime that might have built up

More severe cases may require antibiotics that are either applied to the eye or eyelid directly, or taken as tablets.

Read more about treating blepharitis.

What causes blepharitis?

There are three main types of blepharitis:

anterior blepharitis – where the inflammation affects the skin around the base of your eyelashes

posterior blepharitis – where the inflammation affects your Meibomian glands, found along the eyelid margins behind the base of the eyelashes

mixed blepharitis – a combination of both anterior and posterior blepharitis

Anterior blepharitis can be caused by either:

  • a reaction to Staphylococcus bacteria – these usually live harmlessly on the skin of many people, but for unknown reasons they can cause the eyelids to become inflamed
  • seborrhoeic dermatitis – a skin condition that causes skin to become oily or flaky and sometimes irritate the eyelids, causing the Meibomian glands to block

Posterior blepharitis is caused by a problem with the Meibomian glands, where the glands get blocked by either debris, skin flakes or inflammation.

Sometimes blockages in the Meibomian glands are associated with a skin condition called rosacea. If too much oily substance is being produced, this may be caused by seborrhoeic dermatitis.

Mixed blepharitis, which is the most common, is caused by a combination of both anterior and posterior blepharitis.

Blepharitis isn’t contagious.

Complications

Blepharitis isn’t usually serious, although it can lead to a number of further problems.

For example, many people with blepharitis also develop dry eye syndrome, where the eyes don’t produce enough tears or dry out too quickly. This can cause your eyes to feel dry, gritty and sore.

Serious, sight-threatening problems are rare, particularly if any complications that develop are identified and treated quickly.

Read about the complications of blepharitis.

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Are you protecting your children’s eyes from the sun this summer?

Estimates say up to 80% of a person’s lifetime exposure to UV radiation occurs before the age of 18 [1] yet over three quarters of British parents are unaware of the need to prioritise packing their child’s sunglasses for holidays

Are you protecting your children’s eyes from the sun this summer?

Are you protecting your children’s eyes from the sun this summer?

 monkey monkey eyewear has developed a video to address this. You wouldn’t forget to wear sun cream in the sunshine, so don’t forget to wear sunglasses.

Summer is the easiest time of the year to enjoy the sunshine and get some natural vitamin D, however it’s also a time where we are exposed to harmful UVA & UVB rays. New research released today finds that while a majority of parents protect their children’s skin, most forget to protect their eyes from the harmful ultraviolet rays.

It is estimated children’s annual UV exposure is on average three times higher than adults and since their eyes are not fully developed they have less natural protection from the harmful effects of UV light.[1]

With estimates saying up to 80% of a person’s lifetime exposure to UV radiation occurs before the age of 18 [1], it is important for parents to ensure their children wear sunglasses when outdoors to keep their eyes protected. Children’s pupils are larger than adults, meaning they let in more UV light and their crystalline lens is more transparent, meaning it is less efficient at filtering out UV.[2]

Short term temporary effects of excessive exposure to UV light to children include:

Bloodshot eyes

Swollen eyes

Hyper-sensitivity to light

Sunburn of the eye, known as ‘photo keratitis’ that can cause vision loss for us to 48 hours.[3]

Whilst the majority parents are concerned about packing high factor sun creams and hats to keep their children protected in the sun, almost three quarters don’t consider sunglasses a priority as shown in new research by monkey monkey eyewear. However parents do prioritise packing swimming costumes, snacks and even a Kindle over sunglasses.

Consultant Eye Surgeon Alex Shortt said: ‘This research proves that without a doubt UV light does damage children’s eyes, which typically doesn’t manifest until later in life. It is incredibly dangerous to buy super cheap pound shop sunglasses, which contain dark lenses but no UV filters. With monkey monkey sunglasses, your children are fully protected and you can feel confident when they play in the sunshine.’

[1] World Health Organisation – http://www.who.int/uv/resources/fact/en/fs261protectchild.pdf

[1] The Vision Council – Vision Council Source: http://thevisioncouncil.org/content/uv-eye-protection/kids

[1] World Health Organisation – http://www.who.int/uv/resources/fact/en/fs261protectchild.pdf

[2] SOURCE: The Vision Council http://thevisioncouncil.org/content/uv-eye-protection/kids (SECTION PROTECTING YOUNG EYES)

 

 

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Cataracts – what are Cataracts and why shoudl you be concerned?

Six Tips for Effective Autism Communication

Six Tips for Effective Autism Communication

[Original article on NHS Choices website]

Cataracts occur when changes in the lens of the eye cause it to become less transparent (clear). This results in cloudy or misty vision.

The lens is the crystalline structure that sits just behind your pupil (the black circle in the centre of your eye).

When light enters your eye, it passes through the cornea (the transparent layer of tissue at the front of the eye) and the lens, which focuses it on the light-sensitive layer of cells at the back of your eye (the retina).

Cataracts sometimes start to develop in a person’s lens as they get older, stopping some of the light from reaching the back of the eye.

Over time, cataracts become worse and start to affect vision. Eventually, surgery will be needed to remove and replace the affected lens.

Symptoms of cataracts

As cataracts develop over many years, problems may be unnoticeable at first. Cataracts often develop in both eyes, although each eye may be affected differently.

You’ll usually have blurred, cloudy or misty vision, or you may have small spots or patches where your vision is less clear.

Cataracts may also affect your sight in the following ways:

  • you may find it more difficult to see in dim or very bright light
  • the glare from bright lights may be dazzling or uncomfortable to look at
  • colours may look faded or less clear
  • everything may have a yellow or brown tinge
  • you may have double vision
  • you may see a halo (a circle of light) around bright lights, such as car headlights or street lights
  • if you wear glasses, you may find that they become less effective over time

Cataracts aren’t painful and don’t irritate your eyes or make them red.

When to see an optician

If you have problems with your vision, make an appointment to see your optician (also known as an optometrist). They can examine your eyes and test your sight.

The optician may look at your eyes with a slit lamp or ophthalmoscope. These instruments magnify your eye and have a bright light at one end that allows the optician to look inside and check for cataracts.

If your optician thinks you have cataracts, they may refer you to an ophthalmologist or an ophthalmic surgeon, who can confirm the diagnosis and plan your treatment. These doctors specialise in eye conditions, such as cataracts, and their treatment.

Who’s affected

Cataracts are very common and they’re the main cause of impaired vision worldwide.

In the UK, most people who are aged 65 or older have some degree of visual impairment caused by cataracts. Men and women are equally affected.

Even though cataracts tend to affect older people (known as age-related cataracts), they can also sometimes affect babies and young children (known as childhood cataracts).

What causes age-related cataracts?

The reasons why age-related cataracts develop aren’t fully understood. Like grey hair, cataracts are an inevitable part of ageing that affect different people at different ages.

Cataracts are the result of changes in the structure of the lens over time. It’s thought that the cloudy areas in the lens may be caused by changes in the proteins that make up the lens. However, it’s not clear how or why getting older cause these changes to occur.

As well as your age, there are a number of other factors that may increase your risk of developing cataracts. These include:

Other factors that may possibly be linked to the development of cataracts include:

  • smoking
  • regularly drinking excessive amounts of alcohol
  • a poor diet lacking in vitamins
  • lifelong exposure to sunlight

As the exact cause of age-related cataracts isn’t clear, there’s no known way to prevent them.

Treating age-related cataracts

If your cataracts aren’t too bad, stronger glasses and brighter reading lights may help. However, as cataracts get worse over time, it’s likely that you’ll eventually need treatment.

Surgery is the only type of treatment that’s proven to be effective for cataracts. It’s usually recommended if loss of vision has a significant effect on your daily activities, such as driving or reading.

Cataract surgery involves removing the cloudy lens through a small incision in your eye and replacing it with a clear, plastic one. In most cases, the procedure is carried out under local anaesthetic (where you’re conscious, but the eye is numbed) and you can usually go home the same day.

Almost everyone who has cataract surgery experiences an improvement in their vision, although it can sometimes take a few days or weeks for your vision to settle. You should be able to return to most of your normal activities within about two weeks.

After the operation, your plastic lens will be set up for a certain level of vision, so you may need to wear glasses to see objects that are either far away or close by. If you wore glasses previously, your prescription will probably change. However, your optician will need to wait until your vision has settled before they can give you a new prescription.

Read more about recovering from cataract surgery.